Facial Gunshot Wounds

Abstract

Craniomaxillofacial gunshot injuries, resulting from assault, suicide attempts, and accidental trauma, represent a major public health dilemma in the United States. Due to the extent of injury and resulting osseous and soft tissue loss, facial gunshot wounds pose a unique challenge to the reconstructive surgeon. Initial management should use advanced trauma life support principles with the goal of patient stabilization. Acute operative management should center around wound decontamination, debridement, and temporary closure. Historically, definitive surgical management focused on delayed reconstruction secondary to high rates of wound infections, necrosis, and ischemia. With improvements in imaging modalities, the advent of virtual surgical planning, and the popularization of microvascular free flaps, contemporary methods have shifted toward earlier more definitive reconstruction. Autologous free tissue transfer has resulted in a decrease in hospital stay and the number of overall surgeries. Importantly, due to the variability in injury pattern and complexity in reconstruction, a systematic approach toward intervention is needed to mitigate complications and optimize overall functional and aesthetic outcomes.

An Ode to Gillies and Millard: “The Ten Commandments Applied to Self-Inflicted Head and Neck Gunshot Wounds”

“…Spanning plates have been used before for mandibular reconstruction but rarely for midface reconstruction. 3,4 In our case, these reconstruction spanning plates allowed us to restore the midface width and prevent further soft tissue contracture and to keep remaining skeleton at width 5 ; by doing so, more time was also secured awaiting psychological stability of the patient to proceed with future definitive reconstruction. Although, the disadvantage of using a reconstruction spanning plate is the risk of hardware exposure postoperatively, we felt this was less taxing on the patient with a shorter length of stay than a multi-stage free flap reconstruction and the benefit seemed to outweighs the risk due to considerable collapse of the midface.…”

Formononetin Improves the Survival of Random Skin Flaps Through PI3K/Akt-Mediated Nrf2 Antioxidant Defense System

“…Random skin flap is a method widely applicated to repair skin defects caused by refractory wounds ( Sinha et al, 2012 ), accidental trauma damage ( Volk et al, 2019 ), cancer excisions ( Paradela et al, 2010 ), and diabetes mellitus ( Weng et al, 2018 ). However, flap necrosis, a common postoperative complication, often leads to serious consequences, thus limiting its clinical application.…”

Surgical Decision Making in Complex Facial Gunshot Wound Reconstruction

“…3,4 Early definitive reconstruction of these injuries has been advocated by multiple authors. 3,[5][6][7] The widespread use of microsurgical techniques has advanced many of these algorithmic approaches and allowed for optimization of functional and esthetic outcomes. 3,[7][8][9][10][11] Although microvascular flap utilization and flap selection is often surgeon specific, free tissue transfer is widely considered an invaluable tool for maximizing reconstructive outcomes and FACE 2 (4) minimizing the number of overall surgeries.…”

“…3,[7][8][9][10][11] Although microvascular flap utilization and flap selection is often surgeon specific, free tissue transfer is widely considered an invaluable tool for maximizing reconstructive outcomes and FACE 2 (4) minimizing the number of overall surgeries. 5 Some authors have put forth important considerations and recommendations when selecting the ideal flap; however, there is no consensus on the "first-line" flap for specific facial zones. 4,5,12 The aim of this study is to retrospectively review our experience with complex facial GSWs and to assess the utility of surgical techniques necessary to provide adequate functional and esthetic reconstruction.…”

“…5 Some authors have put forth important considerations and recommendations when selecting the ideal flap; however, there is no consensus on the "first-line" flap for specific facial zones. 4,5,12 The aim of this study is to retrospectively review our experience with complex facial GSWs and to assess the utility of surgical techniques necessary to provide adequate functional and esthetic reconstruction. Additionally, we will investigate variables such as the extent of GSW injury and its anatomic location.…”